Assessment Nyeri
Yudiyanta, Novita Khoirunnisa, Ratih Wahyu Novitasari
Departemen Neurologi, Fakultas Kedokteran Universitas Gadjah Mada,
Yogyakarta, Indonesia
ABSTRAK
Kontrol nyeri tetap merupakan problem signifikan pada pelayanan kesehatan di seluruh dunia. Penanganan nyeri yang efektif tergantung
pada pemeriksaan dan penilaian nyeri yang seksama berdasarkan informasi subjektif maupun objektif. Anamnesis pasien nyeri sebaiknya
menggunakan kombinasi pertanyaan terbuka dan tertutup untuk memperoleh informasi masalah pasien. Selain itu, perhatikan juga faktorfaktor seperti tempat wawancara, sikap yang suportif dan tidak menghakimi, tanda-tanda verbal dan nonverbal, dan meluangkan waktu
yang cukup. Penggunaan mnemonik PQRST (Provokatif Quality Region Severity Time) juga akan membantu mengumpulkan informasi vital
yang berkaitan dengan proses nyeri pasien.(1)
Kata kunci: Assessment nyeri, kontrol nyeri
ABSTRACT
Pain control is still an important issue in health management. An effective management depends on through examination and assessment
based on objective as well as subjective information. Combination of closed and open questions can be utilized in a supportive and noninclined manner in relaxed environment, together with observation on verbal as well as non verbal clues. Use of PQRST mnemonics can help
obtain important information. Yudiyanta, Novita Khoirunnisa, Ratih Wahyu Novitasari. Pain Assessment.
Keywords: Pain assessment, pain control
PENDAHULUAN
Sensasi penglihatan, pendengaran, bau,
rasa, sentuhan, dan nyeri merupakan hasil
stimulasi reseptor sensorik. Nyeri adalah
sensasi yang penting bagi tubuh. Provokasi
saraf-saraf sensorik nyeri menghasilkan
reaksi ketidaknyamanan, distress, atau
penderitaan.1
Kontrol nyeri tetap merupakan problem
signifikan pada pelayanan kesehatan di seluruh dunia. Penanganan nyeri yang efektif
tergantung pada pemeriksaan dan penilaian
nyeri yang seksama baik berdasarkan
informasi subjektif maupun objektif.2
Teknik pemeriksaan/penilaian oleh tenaga
kesehatan dan keengganan pasien untuk
melaporkan nyeri merupakan dua masalah
utama. Masalah-masalah yang berkaitan
dengan kesehatan, pasien, dan sistem
pelayanan kesehatan secara keseluruhan
diketahui sebagai salah satu penghambat
dalam penatalaksaan nyeri yang tepat.
Penanganan nyeri adalah upaya mengatasi
nyeri yang dilakukan pada pasien bayi,
Alamat korespondensi
214
tingkat nyerinya
T Temporal atau periode/waktu
berkaitan dengan nyeri
yang
email: yudiyanta71@yahoo.com
TEKNIK
1. Masalah medis yang berhubungan
2. Masalah yang mempengaruhi penggunaan terapi nyeri
3. Riwayat ketergantungan obat
PENILAIAN NYERI
Ada beberapa cara untuk membantu mengetahui akibat nyeri menggunakan skala
assessment nyeri tunggal atau multidimensi.
Skala assessment nyeri
A. Uni-dimensional:
- Hanya mengukur intensitas nyeri
- Cocok (appropriate) untuk nyeri akut
- Skala yang biasa digunakan untuk
evaluasi outcome pemberian analgetik
- Skala assessment nyeri uni-dimensional
ini meliputi4:
Visual Analog Scale (VAS)
Skala analog visual (VAS) adalah cara yang
paling banyak digunakan untuk menilai
nyeri. Skala linier ini menggambarkan secara
visual gradasi tingkat nyeri yang mungkin dialami seorang pasien. Rentang nyeri diwakili
sebagai garis sepanjang 10 cm, dengan atau
tanpa tanda pada tiap sentimeter (Gambar
1). Tanda pada kedua ujung garis ini dapat
berupa angka atau pernyataan deskriptif.
Ujung yang satu mewakili tidak ada nyeri, sedangkan ujung yang lain mewakili rasa nyeri
terparah yang mungkin terjadi. Skala dapat
dibuat vertikal atau horizontal. VAS juga
dapat diadaptasi menjadi skala hilangnya/
reda rasa nyeri. Digunakan pada pasien
anak >8 tahun dan dewasa. Manfaat utama
VAS adalah penggunaannya sangat mudah
dan sederhana. Namun, untuk periode
pascabedah, VAS tidak banyak bermanfaat
karena VAS memerlukan koordinasi visual
dan motorik serta kemampuan konsentrasi.
B. Multi-dimensional
- Mengukur intensitas dan afektif (unpleasantness) nyeri
- Diaplikasikan untuk nyeri kronis
- Dapat
dipakai
untuk
outcome
assessment klinis
- Skala multi-dimensional ini meliputi4:
McGill Pain Questionnaire (MPQ) (lampiran 3)
Terdiri dari empat bagian: (1) gambar
nyeri, (2) indeks nyeri (PRI), (3) pertanyaanpertanyaan mengenai nyeri terdahulu dan
lokasinya; dan (4) indeks intensitas nyeri
yang dialami saat ini. PRI terdiri dari 78
kata sifat/ajektif, yang dibagi ke dalam 20
kelompok. Setiap set mengandung sekitar
6 kata yang menggambarkan kualitas
nyeri yang makin meningkat. Kelompok
1 sampai 10 menggambarkan kualitas
sensorik nyeri (misalnya, waktu/temporal,
lokasi/spatial,
suhu/thermal).
Kelompok
11 sampai 15 menggambarkan kualitas
efektif nyeri (misalnya stres, takut, sifat-sifat
otonom). Kelompok 16 menggambarkan
dimensi evaluasi dan kelompok 17 sampai
20 untuk keterangan lain-lain dan mencakup
kata-kata spesifik untuk kondisi tertentu.
Penilaian menggunakan angka diberikan
untuk setiap kata sifat dan kemudian dengan
menjumlahkan semua angka berdasarkan
pilihan kata pasien maka akan diperoleh
angka total (PRI(T)).
The Brief Pain Inventory (BPI) (lampiran 4)
Adalah kuesioner medis yang digunakan
untuk menilai nyeri. Awalnya digunakan
untuk mengassess nyeri kanker, namun
sudah divalidasi juga untuk assessment nyeri
kronik.
Memorial Pain Assessment Card
Merupakan instrumen yang cukup valid
untuk evaluasi efektivitas dan pengobatan
nyeri kronis secara subjektif. Terdiri atas 4
komponen penilaian tentang nyeri meliputi
intensitas nyeri, deskripsi nyeri, pengurangan
nyeri dan mood. (Gambar 5)
215
TEKNIK
Catatan harian nyeri (Pain diary)
Adalah catatan tertulis atau lisan mengenai
pengalaman pasien dan perilakunya. Jenis
laporan ini sangat membantu untuk
memantau variasi status penyakit sehari-hari
dan respons pasien terhadap terapi. Pasien
mencatat intensitas nyerinya dan kaitan
dengan perilakunya, misalnya aktivitas harian,
tidur, aktivitas seksual, kapan menggunakan
obat, makan, merawat rumah dan aktivitas
rekreasi lainnya.
Pengkajian nyeri pada geriatri membutuhkan kekhususan disebabkan hilangnya
neuron otak dan korda spinalis mengakibatkan perubahan yang sering diinterpretasikan sebagai abnormal pada
individu lebih muda. Kecepatan konduksi
saraf menurun antara 5-10% akibat proses
menua, hal ini akan menurunkan waktu
respons dan memperlambat transmisi
impuls, sehingga menurunkan persepsi
sensori sentuh dan nyeri.
Nyeri Neuropatik
-
216
TEKNIK
LANSS tersebut, yang tingkat sensitivitasnya
82-91 % dan spesifisitas 80-94 %. Terdiri
atas kuesioner nyeri yang harus dijawab
oleh pasien dan tes sensoris. Bila skor 12
mungkin pasien menderita nyeri neuropatik.
EVALUASI
Evaluasi pengobatan meliputi:
1. Dosis dan pola penggunaan
2. Efektifitas
3. Toleransi obat
Efek samping obat sebaiknya dicatat
menggunakan List of Medicines for Pain and
Side Effects (Lampiran 12) yang dilihat setiap
kali pasien hendak mengkonsumsi obat,
dan untuk menilai keberhasilan pengobatan
dapat juga menggunakan instrumen Pain
and Pain Relief Record8 (Lampiran 13).
Bila pasien mendapat terapi obat opioid,
sebelumnya dinilai terlebih dahulu Opioid
Risk Tool (Lampiran 14). Dengan instrumen
ini pasien dapat dikategorikan risiko rendah,
sedang atau tinggi untuk ketergantungan
terapi opioid. Kemudian setelah pasien
menerima terapi opioid, dinilai pula Addiction
Behaviors Checklist guna mengetahui apakah
sudah terjadi ketergantungan terhadap
terapi opioid (Lampiran 15). Skor ABC >3
DAFTAR PUSTAKA
1.
Raylene MR. 2008; terj. D. Lyrawati, 2009. Penilaian Nyeri. Cited. AHRQ Publication No. 02-E032. Rockville: Agency for Healthcare Research and Quality, July 2002.
2.
3.
Tim Nyeri RSUP Dr Sardjito. Yogyakarta: Protap nyeri RSUP Dr Sarjito. 2012.
4.
Bieri D, Reeve RA, Champion CD, Addicoat L, Ziegler JB. The faces pain scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and
5.
Manz BD, Mosier R, Nusser-Gerlach MA, Bergstrom M, Agrawal S. Pain assessment in the cognitively impaired and unimpaired elderly. Pain Manag Nurs. 2000;1(4):106-115.
6.
Villanueva MR, Smith TL, Erickson JS, Lee AC, Singer CM. Pain assessment for the dementing elderly (PADE): reliability and validity of a new measure. J Am Med Dir Assoc. 2003:4(1):50-51.
7.
Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatr Clin. North Am 2000;47(3):487-512.
8.
Koo PJS. Pain. In: Young LY, Koda-Kimble MA. Applied Therapeutics: the Clinical Use of Drugs, 9th ed. Vancouver: Applied Therapeutics; 2004.
9.
Morley-Forster PK, Clark AJ, Speechley M, Moulia DE. Attitudes toward opioid use for chronic pain: a Canadian physician survey. Pain Res Manag 2003;8:189-194.
10. Kelompok Studi Nyeri. Konsensus Nasional 1 : Penatalaksanaaan nyeri neuropatik. Perdossi: 2011.
217
TEKNIK
Lampiran 1. Initial pain assessment (Pasero C, Mc Caffery)
Physician______________________________________
Nurse ______________________________________
218
TEKNIK
Lampiran 2. Initial assessment management of Cancer Pain
4. Intensity On a scale of 0 to 10, with 0 being no pain and 10 being the worst
pain you can imagine, how much does it hurt right now? How much does it hurt at its
worst? How much does it hurt at its best?
5. Aggravating and relieving factors What makes your pain better? What makes
your pain worse?
6. Previous treatment What types of treatment have you tried to relieve your
pain? Were they and are they effective?
7. Effect How does the pain affect physical and social function?
1. Effect and understanding of the cancer diagnosis
and cancer treatment on the patient and the
caregiver.
2. The meaning of the pain to the patient and the
family.
3. Significant past instances of pain and their effect
on the patient.
B. Psychosocial
assessment
Psychosocial assessment
should include the following:
219
TEKNIK
1. Evaluate recurrence or
progression of disease or tissue injury related to cancer
treatment.
D. Diagnostic
evaluation
2. Perform appropriate radiologic studies and correlate normal and abnormal findings
with physical and neurologic examination.
Bone scan false negatives in myeloma, lymphoma, previous radiotherapy sites.
3. Recognize limitations of
diagnostic studies.
*) Reference: Adapted from Management of Cancer Pain, Clinical Guideline Number 9. AHCPR Publication No. 94-0592: March 1994. Agency for
Healthcare Research & Quality, Rockville, MD.
Nama Pasien:
Tanggal:
Tidak Ada
Ringan
Sedang
Cekot-cekot
Rasa
0)
1)
2)
Berat
3)
Menyentak
0)
1)
2)
3)
0)
1)
2)
3)
0)
1)
2)
3)
Keram
0)
1)
2)
3)
Menggigit
0)
1)
2)
3)
Terbakar
0)
1)
2)
3)
Ngilu
0)
1)
2)
3)
Berat/pegal
0)
1)
2)
3)
Nyeri sentuh
0)
1)
2)
3)
Mencabik-cabik
0)
1)
2)
3)
Melelahkan
0)
1)
2)
3)
Memualkan
0)
1)
2)
3)
Menghukum-kejam
0)
1)
2)
3)
220
TEKNIK
Lampiran 4. Brief Pain Inventory (short form)
2. No
2) On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most.
Right
Right
Left
Left
3) Please rate your pain by circling the one number that best describes your pain at its WORST in the past 24 hours.
0
No pain
10
Pain as bad as
you can imagine
4) Please rate your pain by circling the one number that best describes your pain at its LEAST in the past 24 hours.
0
No pain
10
Pain as bad as
you can imagine
221
TEKNIK
5) Please rate your pain by circling the one number that best describes your pain on the AVERAGE.
0
No pain
10
Pain as bad as
you can imagine
6) Please rate your pain by circling the one number that tells how much pain you have RIGHT NOW.
0
No pain
10
Pain as bad as
you can imagine
8) In the past 24 hours, how much relief have pain treatments or medications provided? Please circle the one percentage
that most shows how much RELIEF you have received.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
No
relief
100%
Complete
relief
9) Circle the one number that describes how, during the past 24 hours, pain has interfered with your:
A. General activity:
0
Does not
interfere
10
Completely
interferes
B. Mood:
0
Does not
interfere
10
Completely
interferes
C. Walking ability:
0
Does not
interfere
222
10
Completely
interferes
TEKNIK
D. Normal work (includes both work outside the home and housework):
0
Does not
interfere
10
Completely
interferes
Does not
interfere
F.
10
Completely
interferes
Sleep:
Does not
interfere
10
Completely
interferes
G. Enjoyment of life:
0
Does not
interfere
10
Completely
interferes
5HIHUHQFH%ULHI3DLQ,QYHQWRU\&KDUOHV&OHHODQG3K'3DLQ5HVHDUFK*URXS&RS\ULJKW8VHGZLWKSHUPLVVLRQ
223
TEKNIK
Lampiran 5.
With
Movement
At
Rest
Scoring:
Score a 0 if the behavior was not observed. Score a 1 if the behavior occurred even briefly during activity
or at rest. The total number of indicators is summed for the behaviors observed at rest, with movement,
and overall. There are no clear cutoff scores to indicate severity of pain; instead, the presence of any of
the behaviors may be indicative of pain, warranting further investigation, treatment, and monitoring by the
practitioner.
Sources:
x Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs. 2000 Mar;1(1):13-21.
x Horgas AL. Assessing pain in persons with dementia. In: Boltz M, series ed. Try This: Best Practices
in Nursing Care for Hospitalized Older Adults with Dementia. 2003 Fall;1(2). The Hartford Institute for
Geriatric Nursing. www.hartfordign.org
224
TEKNIK
Lampiran 6.
Behavior
Breathing
Independent of vocalization
0
x
Normal
1
x
x
Negative vocalization
None
x
x
Facial expression
Smiling or
inexpressive
Body language
Relaxed
Consolability
No need to
console
x
x
x
x
x
x
x
Occasional labored
breathing
Short period of
hyperventilation
x
x
Occasional moan or
groan
Low-level speech
with a negative or
disapproving quality
Sad
Frightened
Frown
Tense
Distressed pacing
Fidgeting
Distracted or
reassured by voice or
touch
x
x
x
x
x
x
x
x
x
Score
Rigid
Fists clenched
Knees pulled up
Pulling or pushing away
Striking out
Unable to console,
distract, or reassure
TOTAL SCORE
(Warden et al., 2003)
Scoring:
The total score ranges from 0-10 points. A possible interpretation of the scores is: 1-3=mild pain; 4-6=moderate pain;
7-10=severe pain. These ranges are based on a standard 0-10 scale of pain, but have not been substantiated in the
literature for this tool.
Source:
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced
Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9-15.
225
TEKNIK
Breathing
1. Normal breathing is characterized by effortless, quiet, rhythmic (smooth) respirations.
2. Occasional labored breathing is characterized by episodic bursts of harsh, difficult, or wearing respirations.
3. Short period of hyperventilation is characterized by intervals of rapid, deep breaths lasting a short period of time.
4. Noisy labored breathing is characterized by negative-sounding respirations on inspiration or expiration. They may
be loud, gurgling, wheezing. They appear strenuous or wearing.
5. Long period of hyperventilation is characterized by an excessive rate and depth of respirations lasting a
considerable time.
6. Cheyne-Stokes respirations are characterized by rhythmic waxing and waning of breathing from very deep to
shallow respirations with periods of apnea (cessation of breathing).
Negative Vocalization
1. None is characterized by speech or vocalization that has a neutral or pleasant quality.
2. Occasional moan or groan is characterized by mournful or murmuring sounds, wails, or laments. Groaning is
characterized by louder than usual inarticulate involuntary sounds, often abruptly beginning and ending.
3. Low level speech with a negative or disapproving quality is characterized by muttering, mumbling, whining,
grumbling, or swearing in a low volume with a complaining, sarcastic, or caustic tone.
4. Repeated troubled calling out is characterized by phrases or words being used over and over in a tone that
suggests anxiety, uneasiness, or distress.
5. Loud moaning or groaning is characterized by mournful or murmuring sounds, wails, or laments in much louder
than usual volume. Loud groaning is characterized by louder than usual inarticulate involuntary sounds, often abruptly
beginning and ending.
6. Crying is characterized by an utterance of emotion accompanied by tears. There may be sobbing or quiet weeping.
Facial Expression
1. Smiling or inexpressive. Smiling is characterized by upturned corners of the mouth, brightening of the eyes, and a
look of pleasure or contentment. Inexpressive refers to a neutral, at ease, relaxed, or blank look.
2. Sad is characterized by an unhappy, lonesome, sorrowful, or dejected look. There may be tears in the eyes.
3. Frightened is characterized by a look of fear, alarm, or heightened anxiety. Eyes appear wide open.
4. Frown is characterized by a downward turn of the corners of the mouth. Increased facial wrinkling in the forehead
and around the mouth may appear.
5. Facial grimacing is characterized by a distorted, distressed look. The brow is more wrinkled, as is the area around
the mouth. Eyes may be squeezed shut.
Body Language
1. Relaxed is characterized by a calm, restful, mellow appearance. The person seems to be taking it easy.
2. Tense is characterized by a strained, apprehensive, or worried appearance. The jaw may be clenched. (Exclude
any contractures.)
3. Distressed pacing is characterized by activity that seems unsettled. There may be a fearful, worried, or disturbed
element present. The rate may be faster or slower.
4. Fidgeting is characterized by restless movement. Squirming about or wiggling in the chair may occur. The person
might be hitching a chair across the room. Repetitive touching, tugging, or rubbing body parts can also be observed.
5. Rigid is characterized by stiffening of the body. The arms and/or legs are tight and inflexible. The trunk may appear
straight and unyielding. (Exclude any contractures.)
6. Fists clenched is characterized by tightly closed hands. They may be opened and closed repeatedly or held tightly
shut.
7. Knees pulled up is characterized by flexing the legs and drawing the knees up toward the chest. An overall troubled
appearance. (Exclude any contractures.)
8. Pulling or pushing away is characterized by resistiveness upon approach or to care. The person is trying to escape
by yanking or wrenching him- or herself free or shoving you away.
9. Striking out is characterized by hitting, kicking, grabbing, punching, biting, or other form of personal assault.
Consolability
1. No need to console is characterized by a sense of well-being. The person appears content.
2. Distracted or reassured by voice or touch is characterized by a disruption in the behavior when the person is
spoken to or touched. The behavior stops during the period of interaction, with no indication that the person is at all
distressed.
3. Unable to console, distract, or reassure is characterized by the inability to soothe the person or stop a behavior with
words or actions. No amount of comforting, verbal or physical, will alleviate the behavior.
226
TEKNIK
Lampiran 7. NIPS (Neonatal Infant Pain Scale)
Assessment nyeri
Ekspresi wajah
0- Otot relaks
1- Meringis
Tangisan
0- Tidak menangis
1- Merengek
2- Menangis keras
Pola napas
0- Relaks
1- Perubahan nafas
Bernapas biasa
Tarikan ireguler, lebih cepat dibanding biasa, menahan napas, tersedak
Tungkai
0- Relaks
1- Fleksi/ ekstensi
Tingkat kesadaran
0- Tidur/ bangun
1- Gelisah
Interpretasi:
Skor 0
tidak perlu intervensi
Skor 1-3
intervensi non-farmakologis
Skor 4- 5 terapi analgetik non-opioid
Skor 6-7
terapi opioid
Lampiran 8. FLACC Behavioral Tool (Face, Legs, Activity, Cry and Consolability)
Indikasi: anak usia <3tahun atau anak dengan gangguan kognitif atau pasien anak yang tidak dapat di nilai dengan skala lain.
0
Face = wajah
Legs = tungkai
Activity = aktivitas
Menggeliat, tegang, badan bolak balik, bergerak Posisi badan melengkung, kaku atau menghentak
pelan, terjaga dari tidur
tiba tiba, tegang, menggesekkan badan
Cry = tangisan
Tidak menangis/merintih (posisi terjaga atau tertidur Mengerang, merengek, kadangkala menangis, Menangis keras menjerit, mengerang, terisak,
pulas)
rewel
menangis rewel setiap saat
Consolability
Interpretasi:
Skor total dari lima parameter di atas menentukan tingkat keparahan nyeri dengan skala 0-10. Nilai 10 menunjukan tingkat nyeri yang hebat.
227
TEKNIK
Lampiran 9.
COMFORT Scale
Indikasi: untuk menilai derajat sedasi yang diberikan pada pasien anak dan dewasa yang dirawat di ruang intensif/ kamar operasi/ rawat inap
yang tidak dapat dinilai mengunakan Visual Analog Scale atau Wong Baker Faces Pain Scale.
Pemberian sedasi betujuan untuk mengurangi agitasi, menghilangkan kecemasan dan menyelaraskan napas dengan ventilator mekanik.
Tujuan dari penggunaan skala ini adalah untuk pengenalan dini dari pemberian sedasi yang terlalu dalam ataupun tidak adekuat.
Instruksi: terdapat 9 kategori dengan setiap kategori memiliki skor 1-5 dengan skor total 9-45.
Kategori
Skor
Kewaspadaan
12345-
Ketenangan
12345-
Tenang
Agak cemas
Cemas
Sangat cemas
Panik
Distres pernapasan
12345-
Menangis
12345-
Gerakan
12345-
Tonus otot
12345-
Tegangan wajah
12345-
12345-
Di bawah normal
Di atas normal konsisten
Peningkatan sesekali 15 % di atas batas normal (1-3x observasi selama 2 menit)
Sering meningkat 15 % di atas batas normal (1-3x observasi selama 2 menit)
Peningkatan terus-menerus 15 %
12345-
Di bawah normal
Di atas normal konsisten
Peningkatan sesekali 15 % di atas batas normal (1-3x observasi selama 2 menit)
Sering meningkat 15 % di atas batas normal (1-3x observasi selama 2 menit)
Peningkatan terus-menerus 15 %
Interpretasi:
Nilai 8 16
Nilai 17 26
Nilai 27 45
228
TEKNIK
Lampiran 10. ID PAIN
: -1
:5
Jika skor anda >2, tanyakan pada dokter tentang kemungkinan anda menderita nyeri neuropatik.
Lampiran 11.
The Leeds Assessment of Neuropathic Symptoms and Signs (LANNS) Pain Scale
Tanggal:
Nama:
A.
-
Kuesioner Nyeri
Pikirkan bagaimana rasa nyeri anda dalam minggu terakhir
Harap disampaikan apakah rasa nyeri anda sesuai dengan pernyataan-pernyataan ini
1.
2.
3.
4.
5.
B.
Apakah nyeri anda terasa sebagai rasa tidak nyaman yang aneh pada kulit?
A. Tidak
B. Ya
(0)
(5)
Apakah nyeri anda menyebabkan kulit di bagian yang terasa sakit kelihatan berbeda dari biasanya?
A. Tidak
B. Ya
(0)
(5)
Apakah nyeri anda menyebabkan bagian kulit yang terkena menjadi tidak normal pekanya terhadap sentuhan?
Apakah rasa tidak nyaman bila kulit digores secara ringan atau rasa nyeri bila memakai pakaian yang ketat dapat untuk menggambarkan keadaan
tidak normal ini?
A. Tidak
B. Ya
(0)
(3)
Apakah nyeri anda muncul tiba-tiba dengan mendadak tanpa ada sebab yang jelas pada saat anda sedang berdiam diri?
A. Tidak
B. Ya
(0)
(2)
Apakah nyeri anda terasa seakan-akan suhu kulit di bagian yang nyeri berubah secara tidak normal?
A. Tidak
B. Ya
(0)
(1)
Tes Sensoris
1.
2.
Alodinia
Menggores kulit dengan kapas secara ringan pada bagian tidak nyeri dibandingkan bagian yang nyeri pada bagian yang tidak nyeri terasa normal,
sedangkan bagian yang nyeri terasa tidak nyaman (kesemutan, mual) berarti ada alodinia
A. Tidak
B. Ada alodinia di bagian yang nyeri
Perubahan nilai ambang nyeri pada tusukan jarum (pin prick thresshold)
Bandingkan rasanya bila jarum suntik ukuran 23G ditegakkan secara pelan-pelan pada bagian yang normal dan pada bagian yang sakit. Bila tidak
terasa pada kedua tempat itu tambahkan beban pada jarum dengan memasangkan alat suntik 2 cc diatasnya, respons dapat: sama; bagian yang
sakit kurang terasa (nilai ambang meningkat); atau bagian yang sakit terasa lebih nyeri (nilai ambang menurun)
A. Rasanya sama
B. Ada perubahan nilai ambang nyeri
(0)
(5)
(0)
(3)
()
229
TEKNIK
Lampiran 12.
*) Adapted from Agency for Health Care Policy and Research. Managing Cancer Pain: Patient Guide. Rockville, MD: U.S. Department of Health and Human Services, March 1994.
Instructions:
1. List each medicine and the amount to be taken each time.
2. Write down what it is for (such as pain, constipation, or nausea).
3. Describe what it looks like (such as purple pill or clear liquid).
4. Write the exact time of day you plan to take it (such as 8 AM & 8 PM for twice a day; or 8 AM, 12 noon, 4 PM, 8 PM, 12 midnight, and 4 AM for
every four hours).
5 List any side effects you should report (such as no bowel movements or a queasy stomach).
Lampiran 13.
Instructions:
1. Pain rating
2. Relief rating
3. Other things I tried
4. Side effects or other problems
5. Comment
occurred).
230
:
:
:
:
:
TEKNIK
Lampiran 14. Opioid Risk Tool
Date _____________________________
Patient Name ________________________________
Item Score
If Female
Item Score
If Male
Alcohol
Illegal Drugs
Prescription Drugs
[ ]
[ ]
[ ]
1
2
4
3
3
4
[ ]
[ ]
[ ]
3
4
5
3
4
5
[ ]
[ ]
Attention Deficit
[ ]
Disorder,
Obsessive Compulsive
Disorder,
Bipolar,
Schizophrenia
Depression
5. Psychological Disease
[ ]
TOTAL
231
TEKNIK
Lampiran 15. Addiction Behavior Checklist
NA
NA
NA
NA
NA
6. Patient used analgesics PRN when prescription is for time contingent use Y
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Other
1. Signicant others express concern over patients use of analgesics
*
Item 1 original phrasing: (Patient used ETOH or illicit drugs), had a low correlation with global clinical judgment. This is possibly associated
with difculty in content interpretation, in that if a patient endorsed highly infrequent alcohol use, he or she would receive a positive rating on
this item, but not be considered as using the prescription opioid medications inappropriately. Therefore, we include in this version of the ABC
a suggested wording change for this item that species problem drinking as the criterion for alcohol use.
232
TEKNIK
Lampiran 16.Patient Comfort Assessment Guide
Circle Rne
aching
sharp
penetrating
throbbing
tender
nagging
shooting
burning
numb
stabbing
exhausting
miserable
gnawing
tiring
unbearable
occasional
continuous
evening
nighttime
3. Rate your pain by circling the number that best describes your pain at its worst in the last month.
No Pain 0 1 2 3 4 5 6 7 8 9 10 Pain as bad as you can imagine
4. Rate your pain by circling the number that best describes your pain at its least in the last month.
No Pain 0 1 2 3 4 5 6 7 8 9 10 Pain as bad as you can imagine
5. Rate your pain by circling the number that best describes your pain on average in the last month.
No Pain 0 1 2 3 4 5 6 7 8 9 10 Pain as bad as you can imagine
6. Rate your pain by circling the number that best describes your pain right now.
No Pain 0 1 2 3 4 5 6 7 8 9 10 Pain as bad as you can imagine
7. What makes your pain better?
8. What makes your pain worse?
9. What treatments or medicines are you receiving for your pain? Circle the number to describe the
amount of relief the treatment or medicine provide(s) you.
a) No 0 1 2 3 4 5 6 7 8 9 10 Complete
Treatment or Medicine (include dose) Relief
Relief
b) No 0 1 2 3 4 5 6 7 8 9 10 Complete
Treatment or Medicine (include dose) Relief
Relief
c) No 0 1 2 3 4 5 6 7 8 9 10 Complete
Treatment or Medicine (include dose) Relief
Relief
d) No 0 1 2 3 4 5 6 7 8 9 10 Complete
Treatment or Medicine (include dose) Relief
Relief
233
TEKNIK
10. What side effects or symptoms are you having? Circle the number that best describes your
experience during the past week.
a. Nausea
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
b. Vomiting
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
c. Constipation
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
d. Lack of Appetite
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
e. Tired
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
f. Itching
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
g. Nightmares
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
h. Sweating
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
i. Difficulty Thinking
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
j. Insomnia
Barely
Noticeable
0 1 2 3 4 5 6 7 8 9 10
Severe Enough
to Stop Medicine
11. Circle the one number that describes how during the past week pain has interfered with your:
a. General Activity
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
b. Mood
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
c. Normal Work
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
d. Sleep
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
e. Enjoyment of Life
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
f. $ELOLW\WR
&RQFHQWUDWH
Does Not
,QWHUIHUH
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
g. Relations with
Other People
Does Not
Interfere
0 1 2 3 4 5 6 7 8 9 10
Completely
Interferes
Prepared by Elizabeth J. Narcessian, MD, Clinical Chief of Pain Management, Kessler Institute for Rehabilitation, Inc.
234